Wiki 21196 & 21141

[cddowd02@louisville.edu]

Has anyone received any denials for 21196 or 21141 for being billed with incorrect place of service? Our surgery schedulers are saying the insurance is giving preauthorization for these, but I am receiving denials showing they are billed with incorrect place of service. I was under the impression that these were Inpatient only codes for Medicare, but can anyone help me understand if they are also Inpatient only for Commercial or Medicaid?

 

[Jmyers1205]

I don't know about Medicaid but you can bill these codes as in or outpatient with commercial insurances. Some insurance companies - mainly Cigna - won't even authorize these codes as inpatient anymore so we have to book the cases as a 23 hour stay.

 

[cddowd02@louisville.edu]

I don't know about Medicaid but you can bill these codes as in or outpatient with commercial insurances. Some insurance companies - mainly Cigna - won't even authorize these codes as inpatient anymore so we have to book the cases as a 23 hour stay.

Thank you for the clarification. I am getting the majority of my denials from Wellcare.